HomeMy WebLinkAbout1204 W 16th St - Engineering
.....
CITY OF PORT ANGELES
DEPARTMENT OF PUBLIC WORKS
. . . . . . INSPECTION REPORT. . . . . . . .
REQUEST
Date I - Z ( - 0 S-
Time / z - >0 ,t'?h-L Received by:O<" YL-IY{ · S C (phone, person)
W . {; (k
Location of Work to be inspected 120<-/ 1-
Name of person requesting inspection f)~ V1 VI 15 r::-_
Address of person requesting inspection ~,........ A Ya..t'--1. 17 Cl-B
I
Type of Inspection (circle appropriate one)
Sewer Foundation Framing Chimney Plumbing Final
Phone No 'if 7 - 'f. 'it{ '7
Permit N~
Sewer Excav Other ('-<-T-.e.... 0
INSPECTION NOTES
Inspected Date I - z. ( - 0 c;-
Remarks 12 e?'a 1>- 2' c: .T
I
Time :5 > 5 0 f/~ By
I~ I V1 W(~t L ~ .f'u{ {
Oe"H1. i 5 E:
C. ;-c{ ~ re/l"'-.lr bc..V\.J
Z - 58 f&\.p\.~
RESTORATION REQUIRED.. . YES
NO ><
J t\l r1J
t-Jj (~ s:i:
vJ /(; -
- ~_t7-;,(
l."CI '-'
I -
I ,
"3 z OUfl
f;'~
~
('l
SURFACE RESTORATION
SURFACE TYPE 0 Unimproved 0 Gravel
o Repaired by City
[] Repaired by Permittee
o No Damage Found
o Asphalt 0 PCC 0 Other
Work Order # 3()33~-o (4
o COMPLETE
o INCOMPLETE
(Continue on reverse side if necessary)
STREET SUPERINTENDENT
(DATE)
~HY or Yon Angeles
Public Works Department
Water Distribution Repair Report
IWork Order No 5D,34,- -0/3
I Crew 7 ( S of- c::../.e.....;
]
DATE REPORTED i - z 0 .- 0':;-
CONDITION EMERGENCY 0 ROUTINE 0 CITIZEN COMPLAINT k
LEAKAGE SURVEY 0 OTHER 0
DATE OF REPAIR.
I - Z I -0-) TIME
ADDRESS /2-64 tJ
~ 30 ,Jtv... DA.M.~.M.
/ r; c:-
REP AlR LOCATION
TYPE OF MAIN L - r SIZE. z; t
I ( ? r
DEPTH OF MAIN .3 Z CLOSEST VALVE DEPTH. ..:::;,
COMPONENT REF AIRED.
MAIN JOINT 0 CIR. BREAK ~ SPLIT BELL 0 LONG BREAK 0
HOLE 0 CLAMP 0 OTHER
SERVICE TAP 0 CORP STOP 0 PIPE 0 CURB STOP 0 FITTING 0
METER SETTER 0 METER 0
LINE VALVE. FLANGE NUTSIBOL TS 0 STEM 0 BONNET 0
HYDRANT BRANCH 0 VAL VE 0 BARREL 0
OTHER.
COMPONENTS OF REF AIR. CLAMP/< DRESSERO OTHER
SITE CONDITION GRA VEL 0 ASPHALT 0 SIDEWALK 0 CURB 0
TOP SOIL AREA 0 SOIL TYPE
CUTS ASPHAL T CUT _IT CURB CUT _IT SIDEWALK_IT
DRlVEW A Y CUT _IT
MAIN CONDITION INTERNAL LINING TUBERCULATION-MINOR 0 SEVERE 0
EXTERNAL CORROSION LOCALIZED 0 EXTENSIVE 0
CHLORINE RESIDUAL SAMPLE AJ/ia. P P.M. 0xed I(J~
(
WATER OFF FROM
M.TO
M.
FROM
M. TO
6fC)uvuJ
M.
SA-ff (€-
A.PP.;RENT CAUSE OF LEAK..